Ko DT, et al. Beta-blocker therapy and symptoms of depression, fatigue, and sexual dysfunction. JAMA 2002;288:351-7.
Bottom line: In patients with HF, MI or HTN, beta-blockers increased the risk of fatigue (NNH 34) & sexual dysfunction (NNH 24), particularly erectile dysfunction in men.
Design
- Systematic review and meta-analysis of 15 trials (n= ~35,000) published up to 2001
- Included RCTs HF, MI or HTN with >100 patients & >6 months of follow-up
Results @ 0.5-6 years
- Fatigue: Beta-blockers 33.4% vs placebo 30.4% (NNH 34), relative risk (RR) 1.15 (1.05-1.26)
- Absolute risk increase 1.8%/year
- Risk greater for older beta-blockers (e.g. propranolol; RR 1.78) than new beta-blockers (e.g. atenolol, metoprolol; RR 1.06)
- Sexual dysfunction: Beta-blockers 21.6% vs placebo 17.4%, RR 1.10 (0.96-1.25)
- Impotence in men: RR 1.22 (1.05-1.41)
- Depression: Beta-blockers 20.1% vs placebo 20.5%, relative risk RR 1.12 (0.89-1.41)
- None of the risks differed based on lipid solubility
